Every day, Doctors Without Borders/Médecins Sans Frontières (MSF) staff confront significant gaps in the availability of medical tools to address the health needs of the people we aim to care for in crisis-affected communities in more than 60 countries. These gaps—which have persisted for as long as MSF has been in operation—contribute to preventable deaths and exacerbate ongoing humanitarian and medical crises.

Violence erupted between internally displaced persons (IDPs) of different ethnic groups in a protection of civilians (PoC) site in Malakal, South Sudan, on February 17, 2016, and continued until the next afternoon. There are strong indications that external military forces were also involved in the fighting.

Globally, the years 2000 to 2015 saw the scaling-up of access to antiretroviral therapy (ART), with a 35 percent decrease in AIDS-related deaths since 2005. A record number of almost 16 million people living with HIV (PLHIV) have been initiated on ART as of mid-2015, three in four of whom live in sub-Saharan Africa, where the needs are most acute. Civil society and public health services alike have rallied to bring new evidence-based treatments and best practices to PLHIV.

The world currently faces its largest global displacement crisis since World War II, with approximately 60 million people currently displaced due to conflict, persecution, and untenable conditions in their home countries. While foreseeable, Europe is still reeling in shock from the sheer numbers of refugees and migrants—approximately one million—who crossed its borders in 2015.

The 2015 Out of Step report presents the results of a survey of 24 countries conducted by Stop TB Partnership and MSF. Building on the first edition of Out of Step published in 2014, this year’s survey tracked of the latest tuberculosis policies, guidelines, and tools across five areas: diagnosis and drug resistance testing; drug-sensitive TB (DS-TB) treatment regimens; MDR-TB treatment regimens; models of care; and regulatory frameworks.

In settings with a high HIV/TB burden and significant shortages of human resources for health (HRH), task shifting strategies have relied on lay workers to provide HIV testing and counselling (HTC) and adherence support for HIV and TB treatments.

While in some countries these tasks were integrated into the work of existing community cadres such as community health workers, new basic cadres have been created and trained in other countries, supported mainly through international funds.